Case Studies from the Medical Records of Leading Chinese Acupuncture Experts

Case studies and medical records are an extremely useful resource for understanding how to differentiate between different syndromes, and provide invaluable precedents for deciding upon appropriate methods of diagnosis and treatment.

This book presents a collection of real case studies of patients who have been treated by prominent acupuncture practitioners in China. The case studies are divided into five sub-categories of disease, and include information on the patient's medical history, presenting complaint, symptoms, tongue and pulse examination, diagnosis, treatment, and prescription as well as the Western diagnosis. More than 170 different case studies are included in the book, covering 73 different types of syndromes and disease. A useful appendix with the Chinese and English names for these syndromes is also included.

Compiled by leading experts at the China Beijing International Acupuncture Training Center (CBIATC), under the editorial direction of leading Chinese clinicians Zhu Bing and Wang Hongcai, this book is a useful reference for acupuncture practitioners and students at all levels.

This is the latest in a series of books published by Singing Dragon in co-operation with the People's Military Medical Press. As with previous publications by Singing Dragon the production quality is high and the standard of translation generally good throughout. The book is well organised via bianbing disease categories, and although it lacks a detailed index there is a clear contents page, an index of Western diseases and a useful glossary of both Western and Chinese medicine terminology. The book includes 176 case studies covering 76 types of disease. The case records are well structured following the familiar TCM framework of chief complaint, signs and symptoms, tongue and pulse, differential diagnosis, treatment principle and point prescription. Each chapter ends with a useful summary and review of differential diagnosis, treatment principles and acupuncture point indications and actions.
    My initial reaction to the book, despite being impressed with the production value and layout, was one of slight trepidation. My concern was whether the book would merely repeat basic TCM theory and axiomatic TCM statements of fact as a background to terse case studies. I was concerned that the book would do little to expand my knowledge of TCM, and to some extent the first few chapters on colds and flu were indeed limited in scope; they did not expand beyond a diagnosis of either wind-cold or windheat and did not incorporate Shang Han Lun or Wen Bing theory.
    For example, an approach to treating lin disease by Professor Yang Jiasan involves reinforcing the yuan qi and regulating qi circulation in the san jiao via the confluent points of the ren mai (Conception vessel). Professor Yang's elegant use of Lieque LU-7 to disperse the Lung qi and free the water passages and Zhaohai KID-6 to reinforce Kidney qi reflects a deep understanding of fluid physiology and the san jiao. By utilising the confluent points of the ren mai he harnesses the multiple synergies and connections of the extraordinary channels rather than relying purely on zangfu bianzheng. Clinical results were therefore achieved with a minimum number of needles.
    A complex case of chronic neurovascular headache lasting over twenty years is presented by Professor Hu Jinsheng. The aetiology is traced back to cold damage twenty years previously, which had blocked the jingluo and had over time resulted in blood stasis. Treatment involved the use of acupuncture, moxibustion and blood-letting to dispel cold, unblock the luo vessels and break blood stasis. The complex development of pathology from acute to chronic is well explained and the case demonstrates how cold damage is not only seen in acute respiratory disorders but can also be associated with chronic illness.
    The work of Professor Shi Xuemin illustrates the influence of biomedical thinking in TCM, for example his reinterpretation of cerebral infarction within the TCM framework. Rather than diagnosis and treatment focusing on the yangming channels and agerelated decline of Kidney and Liver Yin, his understanding is that because a stroke involves loss of consciousness, the treatment principles are to restore consciousness, induce resuscitation and fill up the marrow, for which he uses Neiguan P-6, Renzhong DU-26 and Sanyinjiao SP-6. Prof. Shi's theory presumes that when marrow is ample, the mind will be housed and nourished, the collaterals will be clear and therefore hemiplegia will be reduced.
    Throughout the book the case studies reference and incorporate classical texts in their explanations of physiology and pathology. A case of amenorrhoea references Zang Zhong Jing's Jin Gui Yao Lue: 'in women's diseases, due to deficiency, accumulation of cold, and stagnation of qi, menstruation stops'. This patient is treated for cold retention and blood stasis in the uterus with moxa cones at Guanyuan REN-4 to regulate the chong mai (Penetrating vessel) and ren mai, strengthen yang and dispel cold. The effects of moxibustion are strengthened by burning it on top of medicinal cakes containing the powdered hot and acrid herbs Hu Jiao (fructus Piperis Nigri - peppercorn), Ding Xiang (Flos Caryophylli – clove) and Rou Gui (Cortex Cinnamomi – cinnamon bark).
    This book also details acute cases not usually seen in Western private practice including cases of loss of consciousness and high fever treated with a combination of acupuncture and herbs to clear heat in the blood with blood-letting at Dazhui DU-14 and Weizhong BL-40 to cool the blood and break blood stasis.
    One of the standout aspects of this book compared to other compilations of case studies is the detailed description of needling techniques and point combinations. Throughout the book there are highlighted boxes that describe in detail the needling techniques and point combinations used in the cases. The detailed presentation of Professor Bo Zhiyun's abdominal 'turtle' acupuncture is one example. One of the key differences I noted in these case studies compared to Western examples is the frequency and number of treatments patients received. There are a few exceptions (including the case of amenorrhoea discussed above, which resolved after one treatment), but the majority of treatment recorded here occurred in a subsidised hospital setting as opposed to a private clinic – so that two or three treatments a day were given for acute cases, or daily treatments over several months for more chronic cases.
    This book would have benefitted from diagrams showing needling techniques and flow charts describing some of the more complex pathological processes. Biographies of the experts, summarising their training, background, experiences and influences would also have been welcome. Overall, however, I am glad that my somewhat negative first impression of the book was wrong. This text constitutes more than just a repeat of TCM axioms and has both challenged my existing understanding of Chinese Medicine and provided insight into experienced practitioners' understanding and application of TCM theory. I can therefore recommend this book as a useful resource for both students and experienced practitioners.
Simon Plant